Patient Support Specialist

Role Overview

The Patient Support Specialist will be responsible for managing inbound cases originated from outbound healthcare communication channels, delivering exceptional service aligned with company and department standards to ensure customer satisfaction within the Health Care Center. The role requires providing efficient, courteous, and proactive assistance to both internal and external customers with consistent high quality.

Primary Responsibilities

• Handle inbound calls professionally, demonstrating excellent communication and customer service skills.
• Maintain comprehensive knowledge of Bupa Connect Care products and services, including networks, treatments, and documentation requirements to provide accurate information confidently.
• Record and process provider and client requests into CRM systems following established protocols.
• Ensure accurate maintenance of records, databases, and files.
• Identify and report recurring issues promptly to relevant parties for corrective action.
• Use multiple systems to conduct preauthorization, claims research, contract interpretation, and verify provider network status.
• Interpret client and provider contracts effectively during interactions.
• Deliver superior customer satisfaction and continuously seek ways to enhance service quality.
• Support member recovery from the initial contact, ensuring detailed explanations and maintaining high Net Promoter Scores (NPS).
• Foster strong relationships with stakeholders to guarantee timely and satisfactory case resolutions.
• Manage complaints comprehensively by following departmental policies, initiating necessary escalations, and ensuring appropriate recovery measures are taken.

Required Skills and Qualifications

• Proficiency with computers and software applications.
• Adeptness at multitasking in a dynamic and high-pressure environment.
• Strong troubleshooting, problem-solving, and analytical abilities.
• Excellent follow-up practices and issue resolution skills.
• Background in customer service within insurance or healthcare settings.
• Outstanding communication capabilities.
• Experience in customer service, sales, or call center operations.
• Knowledge of medical and insurance fields is highly advantageous.

Educational Background

Bachelor’s degree in Business Administration, Hospitality Management, Health Services, or a closely related discipline.